New Findings Fuel the Debate Over Steroids for Corneal Ulcers

Most patients with severe bacterial corneal ulcers show long-term benefits from topical steroid treatment, according to findings from the Steroids for Corneal Ulcers Trial. The results were presented at the Cornea Subspecialty Meeting by Thomas Lietman, MD.

Patients with severe ulcers, or Pseudomonas infections, benefit most in the long term. Dr. Lietman and colleagues studied 500 people with bacterial corneal ulcers who were treated with topical moxifloxcin, followed 48 hours later by a 3-week course of a topical corticosteroid (prednisolone sodium phosphate, 1.0%) or a placebo. Overall, no difference in visual acuity (VA) was seen between the groups at 3 months. Even less encouraging: Patients with Nocardia infections fared significantly worse when treated with steroids versus a placebo.

However, when the team removed the Nocardia patients from their analysis and examined long-term data from patients with the most severe corneal ulcers (<20/400), they made a surprising discovery: One year after steroid treatment, those patients showed a 1.7-line mean improvement in VA (range,  0.2-3.1 lines; p = .03). Patients with ulcers caused by Pseudomonas also showed a slight improvement.

Prompt steroid treatment drives better outcomes. Most patients with corneal ulcers, regardless of the etiology or severity, showed a 1.1-line mean improvement in VA when steroid therapy was initiated within 2 to 3 days, compared with later treatment (range, 0.2-2.0 lines; p = .01).

The findings suggest that clinicians need not wait for antibiotics to take full effect before beginning steroid treatments.—Anni Griswold

Financial disclosures. None.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.